District Health Office Posting in Baling, Kedah Darul Aman [Part II - Week 2 (25/11/2007-29/11/2007)]

Hi again,

Let me once again bring you to our posting in Baling in the second week.

SUNDAY 25TH NOVEMBER 2007
- We reported to Pejabat Kesihatan Daerah Baling to KJK Maznah Hussin. We were informed to help the other nurses to run a health campaign in Kampung Masjid Sera.
- We helped the 4-hour-long campaign.
- We assigned each other to various counters whereby we measured the height, weight, calculated the body mass index (BMI) , took blood pressure, checked blood glucose level and we counsel the patients.
- In return, the villagers happily invited us to join in their local luncheon called kenduri.

The above are some photos taken during the health campaign where we had participated in taking the blood pressure, measure the height and weight, calculating the BMI, getting the glucose results from a glucometer and advising the villagers on their diet control and how to lead a healthy lifestyle.

MONDAY 26TH NOVEMBER 2007
- We began our day with a short introduction to communicable diseases of control (CDC) from PPKP Rosli Mansor and PPKP Lem Kiah Kwong.
- We were then introduced to the Communicable Diseases Control Infection System (CDCIS) via an online system and were allowed to help the officer in charge register the new cases of communicable disease online.
- In the afternoon, we proceeded to the Baling Hospital accompanied by PPKP Rosli Mansor to investigate a newly reported case of typhoid.
- Next, we were brought to Kampung Muda where we observed the health officers collect samples of water and stools of family members. The members were also counseled regarding sanitation.
- We then observed how the health officers sprayed sodium hypoclorite 10 % around infected areas.
A brief introduction of Communicable Diseases of Control (CDC) were given by both PPKP En. Rosli and PPKP Mr. Lem. We were later being introduced the programme CDCIS (Communicable Diseases of Control Information System) by PPKP En. Rosli.

CDCIS

CDCIS is a online programme for the officers in charge to register the new cases of communicable diseases. Once the cases are registered, the cases can be reviewed by the higher health centres. By this, the number of cases in the whole of Malaysia which has been reported can be traced and pre-cautions can be taken before the communicable diseases spreads. CDCIS is also useful in the sense of keeping the records.

The cases will be notified by the doctors either in the Hospital or in the private sector. The doctors will called up the Health Office to notify them and povide them with necessary information.

There are 9 communicable cases which need to be notify within 24 hours. They are:-

1) Dengue fever and Dengue Haemorrhagic fever

2) Yellow fever

3) Ebola

4) Cholera

5) Food Poisoning

6) Plaque

7) Rabies

8) Polio

9) Diphteria

The other communicable diseases can be notify within 1 week.

The above photos showed initially we went to the Baling Hospital as there was a typhoid case been reported.

In the afternoon, we went to the resident of the patient who was suspected of typhoid. The third photo showed PPKP En. Rosli spraying sodium hypochlorite 10% around the breeding grounds. This is done to prevent the spread of the flies as the flies are the main vector for causing typhoid. The fourth photo showing him again taking the sample of the water which will be sent to Penang Hospital for further investigations. It is learnt that the patient's resident uses 2 types of water (the JBA and the water from the hillside). Thus, samples of water were taken from the 2 water sources. The last photo showed a large dug-up place where the villagers throw their rubbish.

At the end of the spraying and the samples collecting, each villager who is related to the patient were given a swab to culture their stools the next day. Sampes are taken from the family members as to detect probable carrier states. The villagers involved were taught the correct way of collecting the culture. The following day, the samples of stools were collected and then immediately sent to the Sungai Petani Hospital for further tests.

TUESDAY 27TH NOVEMBER 2007
- We arrived at Pusat Pengawalan Vektor daerah Baling in the morning and reported to PPKP Rozaidi Shamsudin and PPKP Abdullah Yusof.
- Both the health officers gave a concise briefing regarding outbreak investigation.
- We learned that Baling has the fourth highest dengue cases in Kedah recording 211 cases up till November 2007 following Kota Star, Kuala Muda and Kulim respectively.
- We also learned how fogging for dengue infected areas, were carried out. Under normal circumstances, fogging would be done in a radius of 200m around the affected area.
- The health officers also mentioned about other common outbreaks such as filariasis, malaria and Japanese Encephalitis.

The photos showed the vector department where we were being given a brief idea of what the department do. Later we were told that there was a fogging session in the following week and we urged to follow and observed what they do.

Over here, in this department, there is also a programme where they key in every cases noted. For example, if there is a case of dengue noted, they will sent out teams to do fogging. At the same time, they have the right to 'saman' those houses where the breeding of mosquito is found. In the programme showed to us, each person who is been 'saman' will be noted until they have pay the compound.

If there is a case of suspected dengue noted, fogging will be done once. However, if there is a positive dengue case noted, the second time of fogging is taken place.

WEDNESDAY 28TH NOVEMBER 2007
- A short briefing regarding non-communicable diseases was given by PPKP Cik Haslinda.
- She explained that the non-communicable diseases covered by Pejabat Kesihatan Daerah Baling included diabetes, hypertension, cardiovascular diseases, family violence and others.
- The Baling district is the pioneer for Blindness Programme ( Program Kebutaan). Another clinic set up by this district is ‘Quit Smoking’ clinic.
- PROSTAR is another branch of service provided by the district health office. It encompasses ‘Program Sihat untuk Remaja’. In this programme, teenagers between ages 13 to 25 years are educated and exposed to various health hazards such as obesity and diabetes, and are also introduced to healthy diet.
- Finally, we were also informed of the yearly carnival that is held for 2 to 3 days long. This carnival includes a health campaign, blood screening, counseling and educational exhibitions. Its aim is to expose the public for primary prevention of diseases.

This photo showed us being brief of Non-Communicable Disease of Control (NCDC) by PPKP Cik Haslinda. At the same time, PROSTAR is also been introduced to us.

THURSDAY 29TH NOVEMBER 2007
- The topic scheduled for the day was ‘Outbreak investigation ’. PPKP Rosli Mansor briefed us on how a certain outbreaks such as food poisoning and cholera were tackled in Baling.
- In terms of food poisoning, one episode is considered when one or more cases of similar symptoms develop in individuals. The definition of case in association with food poisoning includes an individual developing symptom or symptoms of food poisoning and receives treatment for these symptoms.
- Epi-Info is a statistical table that the district health office forms to calculate whether the food consumed is significant to that particular episode of food poisoning. This data helps the health officers identify the true cause of food poisoning.
- From the point of notification of case, the health officers would sent teams to clarify the cases with the affected individuals that include interviews to identify whether the symptoms suffered are due to food poisoning or a contribute of other factors. Once it has been clarified, then the patients and controls (those consumed the same food but are asymptomatic) are investigated. The final report concerning the outbreak of food poisoning is then sent to the health ministry at state level.
- In terms of cholera outbreak, one case in one locality during one incubation period is considered a cholera outbreak.
- Upon notification of case, and operation room (Bilik Gerakan) is formed. This unit consists of a health officer (Penolong Pegawai Kesihatan Perseketuan or PPKP), Control team, Investigation team, Case detection team and Health control unit.
- The health officer is the head of the operation team. The functions of the control team include isolating and secluding sites and premises identified to be the source of outbreak. Such actions are carried out according to Act 1988. The investigation team identifies the affected individuals in the hospital and interviews them. Among the functions of case detection team is to collect samples from the alleged source of infection. The health control unit plans talks and exhibitions to educate the public regarding such outbreaks.
- Upon the setting of the operation room, these teams are then sent to sites affected to carry out their respective responsibilities.
- For an outbreak of cholera, the activities of patients are tracked 5 days prior to the onset of symptoms. The case detection team goes to the site to collect samples of rectal swabs and disinfection of areas are done with disinfectants such as sodium hypochlorite 10% or Lysol 1:10.

District Health Office Posting in Baling, Kedah Darul Aman [Part I - Week 1(19/11/2007-22/11/2007)]

Hi everyone,

Let me first introduce my group members who were posted to Baling for our District Health Office posting from 19th November 2007 till 13th December 2007. Our group is headed by Chng Kay Ly and we had a fabulous and wonderful time there.

From left to right: Chng Kay Ly (leader), Charlotte Marie, Cheah Boon Eu, Jeevan, Deva Vinod and S. Dinesh

Hereby, I shall bring you to what we had done in our first week of our posting in Baling.

MONDAY 19TH NOVEMBER 2007
- Reported to Pejabat Kesihatan Daerah Baling(District Health Office) to KJK Maznah Hussin and FMS Dr. Delima Kalsom binti Abdul Wahab.
- We later left for Klinik Kesihatan Kupang and was introduced to FMS Dr Zamri Mansor and the medical officers.
- Dr Azira, one of the medical officers, later briefed us on the various departments that are available in the clinic. Among those available are the pathology laboratory, pharmacy, computer room, library, dental clinic, psychosocial rehabilitation (PSR), immunization room and many more.

The above photos are taken when we were posted at the District Health Office and Klinik Kesihatan Kupang; respectively.

TUESDAY 20TH NOVEMBER 2007
- We reported to Klinik Kesihatan Kupang. Our topic of study for the day was Maternal Child Health (MCH) and Family Planning.
- We were separated into 3 pairs and were assigned cases pertaining child heath, maternal health and family planning. The cases clerked were later discussed with the Family Medical Specialist (FMS) Dr Zamri.

- Jururawat Kesihatan Umum Haliza taught us the process of booking and we were allowed to perform booking for the patients under her close supervision.
- We also discussed with him the advantages and disadvantages of family planning, the criterias available and he diligently taught us about the history taking of family planning.
- In the afternoon, we had a brief class on psychosocial rehabilitation(PSR); again by Dr. Zamri.

The photos are taken in Klinik Kesihatan Kupang during our MCH posting where antenatal check-ups, child healthcare and family planning were taken place. The first photo was taken when one of our group member were given an opportunity to book a pregnant lady with the gestation of 15 weeks. The photo on the right is taken during a child (at age 1 month) follow-up and the mother of the child also came for postnatal check-up and family planning dine by the staff nurse present.

MCH

MCH or better known as Maternal and Child Health has its own objectives as:-
1) To provide care and consultation to mothers during pregnancy
2) To screen women at potential risk of complications and difficulties throughout the three trimesters
3) To diagnose complications and plan treatment early
4) To reduce maternal apprehension regarding delivery
5) To reduce maternal and infant mortality and morbidity
6) To educate mothers regarding the available opportunities of family planning and the advantages and disadvantages to adhering to such programmes
7) To educate mothers about proper personal hygiene
8) To help mothers understand the need of proper care and proper environment for optimal health of infant

Antenatal

Regarding 'Booking' which is done for pregnant women who had their first check-up, it is normally done by the Community Nurse in Klinik Desa and Staff Nurse in Klinik Kesihatan. In Klinik Kesihatan, a red book and another card is being filled up simultaneously. The red book is later given for the pregnant lady to keep and they were informed to bring during their following follow-ups. There will also be another big record book which is meant to record all the patients who come for follow-up. From there, the nurses will be able to trace every patients for their compliance of follow-ups. As for the card, it will be kept as a copy in the Klinik Kesihatan. In both the books and the card, certain information are being recorded. The personal information, the height, weight and blood pressure were first taken as the vitals. Later, a blood test on Hb level, blood group and the Rhesus were taken. At the same time, a drop of blood will be use to test for the HIV status with the consent given by the patients. A urine test is also taken to confirm the pregnancy as well as to check for the albumin and sugar content in the urine. After that, the patients will be called into a room where a thorough medical examination is performed. During the thorough medical examination, the patient is also taught on how to do a "Breast Self Examination". After that, the patient is being advised on their food diet as well as some supplements (eg. iron tablets, etc) were given. A date is being given to the patient to come back for the next follow-up. If the patient defaulted the follow-up, the Staff Nurses will go to their house during their "Home Visit" period to follow-up the patients.

Besides that, there is a tagging system during booking. There are 4 different colour tagging - White, Green, Yellow and Red.

White: Patient has no complication during the follow-up of the pregnancy.

Green: Patient has minor complications (eg. Rhesus -ve, history of recurrent miscarriage, Anaemia, etc) and need to see a Consultant with a follow-up date given.

Yellow: Patient has complications (eg. GDM, HIV +ve, etc) and need to seek the Consultant within 48 hours

Red: Patient has complications (eg. Eclampsia, PIH, DKA, etc) and need to seek the Consultant immediately

Postnatal

Postnatal mothers also received follow-up in the Klinik Kesihatan or Klinik Desa respectively. However, those receiving follow-up in the two areas mentioned has to be confirmed by the doctors of any complications. This is also done by the Community Nurse in Klinik Desa and Staff Nurse in Klinik Kesihatan.

Child Health

After a delivery, the new infant is supposed to be follow-uped until the immunization status is completed. The mother of the child will be given a card with a growth chart and the immunization chart printed on it. She have to bring the child to either the Klinik Desa or Klinik Kesihatan for the follow-up. During the follow-up, the height, weight, and the head circumference were measured again either by the Community Nurse or Staff Nurse according to either Klinik Desa or Klinik Kesihatan respectively. Everytime a child is being measured, it is recorded in the card mentioned. Then, the growth chart is being plotted to see whether the child is growing well or not. If the child is coming for immunization, then the a thorough physical examination is done on the child to make sure that the child is healthy before the immunization is given.

PSR

PSR; Psychosocial Rehabilitation is a process to enable and to encourage those individuals with mental problems to achieve independency in the community, so that they are able to take care of their daily needs. In this programme in Klinik Kesihatan Kupang, the individuals are given chances to do sourvenirs, cooking, etc.

Among the objectives for the PSR are:-
1) To enable the individual to adjust to attain his optimal level of independence, psychologically, socially, physically and economically.
2) To enable the mentally patients to understand and able to control their own illness, achieve their optimal functions and to obtain independency.

The photos above are some of the sourvenirs done by the individuals when they spent their time in the psychosocial rehabilitation. They normally attend the rehabilitation on every Tuesday in the morning. Currently there are less than 10 patients as many of them has succeeded to be more independent and had found a better job.

WEDNESDAY 21ST NOVEMBER 2007

- We reported to Klinik Kesihatan Kupang. Jururawat Kesihatan Norolasikhin and Jururawat Kesihatan Hamzah divided us into 2 groups and took us for home visit for postnatal mothers and neonatal jaundice in various villages. Among the villages that we visited were Taman Sri Landak (postnatal 8 days with G6PD deficiency male neonate) and Kampung Seberang Ketil (postnatal 9 days with G6PD deficiency female neonate).
- Later, we visited Klinik Desa Kampung Pisang. We helped in the booking process.
- Our final visit for the morning session was to Kampung Bendang where we visited a mother in her 20th postnatal day
- In the afternoon, we were given a brief lecture on geriatrics by Dr Zamri.

Home Visit

Home visit is done normally for those patients who are unable to seek medical treatment because transportation is not available in their places. However, home visit normally is done for postnatal mothers and infants with medical illness such as Jaundice, G6PD (Glucose-6-Phosphate Deficiency).

1st photo: Taken in Taman Sri Landak with S/N Norolasikhin checking on a 8 days old neonate who had G6PD. A thorough medical check-up with vital signs was taken for the mother of the child with the help of one of our group member.

2nd & 3rd photos: Taken in Kampung Seberand Ketil with S/N Norolasikhin weighing the baby followed by a thorough medical examination on the 9 days old neonate. The way of weighing the baby is done during Home Visit only as it is hard for them to carry around the weighing machine during the Home Visit.

4th photo: Taken in Klinik Desa (Community clinic) Kampung Pisang where one of our group member is seen taking blood pressure for a lady who came for follow-up of her pregnancy.

5th & 6th photos: Taken during a home visit in Kampung Bendang where S/N Norolasikhin and S/N Hamzah is seen doing a follow-up for both mother and 20 days old neonate.

THURSDAY 22ND NOVEMBER 2007
- We introduced ourselves to a group of elderly people above 50 years of various background who are members of a society called ‘Warga Emas’.
- We joined them in their morning activity of Tai Chi and Qi Gong. We later on joined them for a light refreshment prepared by the elderly folks themselves.

Warga Emas

"Warga Emas" better known as the Old Folks has formed a group of their own. They usually gather in Klinik Kesihatan Kupang on every Thursday from 8am till 10am. They will meet up; share their experiences and do some light exercises like 'Tai Chi' and 'Qi Gong'. Below are some photographs taken with their consents during their exercise activities. They normally exercise for about 45 minutes and then they will be served with some refreshment prepared by themselves.

Our experiences during the 2nd, 3rd and 4th week of out posting in the District Health Office posting in Baling will be posted soon.